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NAVMED P-5088 




Vol. 45 



Friday, 25 June 1965 



No. 12 




CONTENTS 



MEDICAL ARTICLE 

Surgical Management of Traumatic Intracardiac 

Lesions 1 

FROM THE NOTE BOOK 

CAPT A. Graybiel Receives Award 6 

Infant Saved 7 

Blood Recruitment Poster 8 

Acknowledgment 8 

Heroic Navy Nurse Hailed by Hometown 8 

Correspondence Courses 8 

Premiere of BUMED Film "Nurse Corps, USN" at 

American Nurses' Association Convention 9 

Navy Nurse Corps Anniversary Breakfast 9 

DENTAL SECTION 

Acquired Dental Defects and Salivary Gland Lesions 

After Irradiation for Carcinoma 10 

Ultrasonic Prophylaxis in a Naval Vessel 11 

Washington's Missing Dentures: Solving the Mystery — 11 

Treatment Planning Principles 11 

Personnel and Professional Notes 12 



AVIATION SECTION 

Promotion of Flight Safety Recognized 14 

Aviation Medical Acceleration Laboratory Naval Air 

Development Center, Johnsville, Pa. 14 

Aviators Are A-OK!— Confinement Study A Major 

Success 15 

Ejection Vertebral Injuries 17 

BUMED Instruction 6110.8 19 

RESERVE SECTION 

Appreciation for Medical Services Rendered 19 

Letters of Commendation 20 

Medical and Dental Students Aboard USS HUSE ___ 20 

EDITORIAL DESK 

CAPT Voris Receives International Academy Mem- 
bership Certificate 21 

Secretary of the Navy Commends Navy Medical De- 
partment 21 

PG Short Courses for Medical Department Officers 
Sponsored by the Department of the Army During 
Fiscal Year 1966 21 

American Board Certifications 23 

In Memoriam 23 



United States Navy 
MEDICAL NEWS LETTER 



Vol. 45 



Friday, 25 June 1965 



No. 12 



Rear Admiral Robert B. Brown MC USN 
Surgeon General 

Rear Admiral R. O. Canada MC USN 
Deputy Surgeon General 

Captain F. R. Petiprin MSC USN, Editor (Acting) 

William A, Kline, Managing Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine Captain J. H, Schulte MC USN 

Reserve Section Captain C. Cummings MC USNR 

Submarine Medicine Captain J. H. Schulte MC USN 



Policy 
The U.S. Navy Medical News Letter is basically an 
official Medical Department publication inviting the 
attention of officers of the Medical Department of the 
Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to 
medicine, dentistry, and allied sciences. The amount 
of information used is only that necessary to inform 
adequately officers of the Medical Department of the 
existence and source of such information. The items 
used are neither intended to be, nor are they, sus- 



ceptible to use by any officer as a substitute for any 
item or article in its original form. All readers of the 
News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter 
to: Commanding Officer, U.S. Naval Medical School, 
National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new 
addresses. 



FRONT COVER: The original U. S. Naval Hospital, Great Lakes, Illinois was commissioned in 1911. With four 
wards and sick v officers' room, it then offered a capacity of only 81 beds. The operating rooms were illuminated by 
skylights during the day and a cluster of five tungsten lamps at night. 

The old hospital was doing its share in caring for the wounded of World War I, when an influenza epidemic 
broke out in the Fall of 1918. Its capacity was increased to admit as many as 300 patients in one day. 

Upon U. S. entry into the second World War, there was an immediate increase in admissions. Casualties filled 
the hospital to capacity. During 1943 there were 38,384 admissions. The all time peak was 8,179 in-patients. 

The new $15,000,000, 1,000 bed hospital was dedicated on 9 December 1960, operational on 3 January, 1961, and 
is a modern structure in every respect. The 12-story hospital, with a basement and two story penthouse, occupies 
approximately 5,877,000 cubic feet. The building has a concrete foundation, structural steel framing, steel joists, 
concrete floors, and brick faced exterior walls with brick backup. The hospital, so constructed that 1000 beds 
can easily be added, is the finest Naval Hospital between Philadelphia and San Francisco. 

The 100% air-conditioned hospital features a closed circuit television system, piped in oxygen; a network of eight 
elevators and many other facilities. 

Great Lakes was chosen for the site of a Hospital Corps School which opened in February 1942. The first class 
graduated one month later. Five hundred student corpsmen were graduating every three months. 

At the present time the Hospital and Hospital Corps School are staffed with about 225 officers, including Med- 
ical Corps, and Dental Corps, Medical Service Corps, Nurse Corps, Chaplain Corps, and Civil Engineer Corps Offi- 
cers; 450 enlisted personnel; and 415 civilians. The Hospital Corps School has a student body varying from 500 to 
1000 personnel. Classes are convened every week and are of 16 weeks duration. 

The Great Lakes Naval Hospital is a general and teaching hospital providing services for active duty and retired 
Navy, Marine, Army and Air Force personnel and their dependents. — Editor 

The issuance of this publication approved by the Secretary of the Navy on 4 May 1964. 

U.S. NAVY MEDICAL NEWS LETTER 



MEDICAL ARTICLE 

SURGICAL MANAGEMENT OF TRAUMATIC INTRACARDIAC LESIONS* 

Arthur C. Beall, Jr., MD, Harold F. Hamit, MD, Denton A. Cooley, MD, and 

Michael E. De Bakey, MD. 



Sixty-seven years have passed since the first suc- 
cessful clinical cardiorrhaphy for trauma. 8 During 
this period of time methods of treating cardiac 
wounds have varied greatly. 2 Regardless of the 
primary method of management, however, intra- 
cardiac lesions following trauma present a unique 
problem to the surgeon. Until recently, such injuries 
were considered to be only of academic interest. 

With development of satisfactory technics of total 
cardiopulmonary bypass and their widespread clinical 
application in open heart surgery, traumatic intra- 
cardiac lesions now are within the realm of surgical 
correction. 1 Six patients with such defects have been 
managed successfully with the aid of cardiopulmonary 
bypass in the city-county hospitals of Houston and 
Harris County, Texas. Review of this experience 
demonstrates the need for accurate anatomical diag- 
nosis and definitive repair of the intracardiac lesion 
following recovery from the acute episode associated 
with injury and forms the basis for this report. 

PLAN OF MANAGEMENT 

All patients with thoracic trauma are seen first in 
the emergency room, which is equipped for any 
eventuality. They are disrobed completely, in order 
that no associated injury will go unrecognized, and 
are examined promptly for the presence of shock or 
pericardial tamponade, for signs of intrathoracic 
injury, and for status of peripheral pulses. Simul- 
taneously, a route for the rapid intravenous admin- 
istration of fluids and drugs is established, and blood 
is obtained for laboratory examination and for typ- 
ing and crossmatching. Crystalloid and colloid solu- 



* From the Cora and Webb Mading Department of Surgery, Baylor 
University College Df Medicine, and the Jefferson Davis and Ben 
Taub General Hospitals, Houston, Texas. 

Supported in part by the U.S. Army Research and Development 
Command, Contract No. DA-^9-007-MD-2523, and the U.S. 
Public Health Service (HE-03137) and (HE-5387). 

Read before the Twenty-fourth Annual Session of the American 
Association for the Surgery of Trauma, Chicago, Illinois, October 
1-3, 1964. 

Reprint address: Arthur C. Beall, Jr., MD, Cora and Webb 
Mading Department of Surgery, Baylor University College of 
Medicine, Houston, Texas "77025. 



tions, vasopressors, and whole blood are given as 
indicated. 

Sucking wounds of the chest are closed rapidly by 
Vaseline® gauze pressure dressings or temporary 
suture. Hemothorax and/or pneumothorax are man- 
aged by immediate institution of intercostal thora- 
costomy tube drainage. If the patient's condition 
permits, roentgenographic and electrocardiographic 




Fig. 2. (Frontispiece.) Drawing illustrating tech- 
nic of pericardicentesis by paraxyphoid approach. 



U.S. NAVY MEDICAL NEWS LETTER 



examinations are performed. However, if signs of 
pericardial tamponade are present or the patient 
fails to respond to the above measures, pericardi- 
centesis is performed without delay (Fig. 2), often 
simultaneously with examination and onset of ther- 
apy. If the patient's condition is stable without peri- 
cardicentesis or stabilizes following a single peri- 
cardial aspiration, he is taken to the recovery room 
for intensive observations. Otherwise, he is taken 
rapidly to the operating room where pericardicentesis 
again is performed. Should response to the second 
pericardial aspiration be immediate and lasting, the 
patient is moved to the recovery room; if not, the 
pericardial needle is left in place and cardiorrhaphy 
is performed. Should cardiac arrest occur at any 
time, immediate thoracotomy is performed, whether 
in the emergency room, recovery room, or operating 
room. By this plan of management (Fig. 3) all 
deaths, of necessity, fall into the operative group and 
statistical comparison of groups is meaningless. 
Nevertheless, experience with this method of man- 
agement over more than a decade and a half was 
demonstrated that it offers the patient with a heart 
wound the best chance of survival. 2 • i 



->N0 TREATMENT- 






->-| RECOVERY 




•PERICARDICENTESIS 
— ^-THORACOTOMY 

\ 

DEATH 



Fig, 3. Schematic illustration of plan of managing 
cardiac injuries. Patient progresses through neces- 
sary treatment toward recovery. In event of cardiac 
arrest at any stage, immediate thoracotomy is per- 
formed. 

Patients with blunt trauma to the heart present 
problems similar to those with penetrating injuries, 
and mechanical derangements such as pulmonary 
collapse and pericardial tamponade are managed as 
described above. Myocardial rupture usually is of 
such severity that the patient does not reach the 
hospital alive, but occasionally rapid relief of tam- 
ponade and cardiorrhaphy will result in salvage. 
Most common among cardiac injuries resulting from 
blunt trauma are myocardial contusions and partial 



thickness lacerations which usually resolve without 
specific therapy. 7 These patients, therefore, generally 
require only supportive care, reserving specific ther- 
apy for the rare case of intracardiac injury. 3 

Both penetrating and nonpenetrating injuries of 
the heart may result in intracardiac damage, and 
these injuries may or may not be associated with 
significant hemodynamic alterations depending upon 
the structures involved and the magnitude of the 
injury. Prior to definitive therapy for those intra- 
cardiac injuries which require correction, an accu- 
rate anatomical diagnosis by catheterization and /or 
angiographic studies is necessary. Therefore, in spite 
of immediate availability of total cardiopulmonary 
bypass using disposable plastic oxygenators* primed 
with five per cent dextrose in distilled water, 5 defini- 
tive repair of the intracardiac defect is not possible 
at the time of primary therapy even if cardiorrhaphy 
is required or elected. 1 Methods of primary manage- 
ment thus are selected on their own individual 
merits, as described above, rather than predicated 
on the possibility or presence of an intracardiac 
injury. Management of the six cases to be presented 
will be considered separately then in regard to pri- 
mary and to definitive therapy. 4 

CLINICAL MATERIAL 

Experience with open heart surgery employing 
total cardiopulmonary bypass in the Baylor Uni- 
versity College of Medicine Affiliated Hospitals now 
exceeds 2800 clinical cases, allowing familiarity with 
numerous congenital and acquired cardiac lesions 
similar to the six traumatic intracardiac injuries to 
be described. Through a combination of geogra- 
phical and racial factors, an extremely large volume 
of trauma is routed to two, of these hospitals, Jeffer- 
son Davis and Ben Taub General, the city-county 
hospitals for the indigent of Houston and Harris 
County, Texas. Between 1950 and 1963 there were 
177 patients with penetrating cardiac wounds alive 
on admission to these hospitals, and their manage- 
ment was reported in detail elsewhere. 2 '* From this 
clinical material the described methods of manage- 
ment evolved and the following six cases were drawn, 
as summarized in Table I. 

Case Reports 

Case 1: A 24-year-old man was admitted to the 
hospital on September 16, 1956, in profound shock 
following multiple stab wounds of the chest and 

* Travenol Laboratories, Inc., Morton Grove, Illinois. 

U.S. NAVY MEDICAL NEWS LETTER 



TABLE I 

Summary of Patients with Traumatic Intracardiac Defects 



Case Age Sex 



Method of 
Injury 



Anatomic 
Diagnosis 



Management of Cardiac Injury 



Primary 



Definitive 



Results 



1 24 Mble 



50 Male 



44 Male 



None 



Open suture 
repair 



Pericardicentesis Open suture 
repair 

Pericardicentesis Open suture 
repair 



4 
5 



28 

39 



Male 
Female 



6 20 Male 



Stab wound Aortic-right 
ventricular 
fistula 

Stab wound Aortic-right 
ventricular 
fistula 

Stab wound Aortic-right 
ventricular 
fistula 
Stab wound Interventricular Pericardicentesis Open suture 

septal defect repair 

Blunt trauma Aortic valve None 1 ) Open suture 

regurgitation repair 

2) Prosthetic 
replacement 
of aortic valve 
Stab wound Interventricular Pericardicentesis Open suture 
septal defect repair 



Asymptomatic 
Asymptomatic 
Asymptomatic 

Asymptomatic 

1) Recurrence 

2) Asympto- 
matic 

Asymptomatic 



abdomen. Tube thoracostomy and intravenous 
fluids and whole blood were employed for resuscita- 
tion, and two lacerations of the jejunum were re- 
paired at celiotomy. He was discharged from the 
hospital 15 days later, but returned on October 19, 
1956, complaining of precordial pain, easy fatiga- 
bility, and dyspnea on exertion. The heart was 
grossly enlarged and a harsh, continuous murmur 
was heard over the entire precordium, loudest in the 
third intercostal space just to the left of the sternum. 
Right heart catheterization demonstrated a left-to- 
right shunt at the ventricular level with a right ven- 
tricular pressure of 26/9 mm. Hg. 

Following anatomical diagnosis right ventriculot- 
omy was performed on November 21, 1956, using 
total cardiopulmonary bypass. A 5 x 15 mm, linear 
defect was found in the posterior wall of the right 
ventricular outflow tract communicating with the 
aorta (Fig. 4) and was repaired with interrupted fig- 
ure-of-eight sutures. The patient's recovery was un- 
eventful and he was discharged from the hospital on 
December 3, 1956. Except for an episode of homo- 
logous serum hepatitis in February, 1957, he has 
remained asymptomatic. 1 

Case 2: A 50-y ear-old man was admitted to the 
hospital on June 23, 1957, in profound shock shortly 



< v (fe 




Fig. 4. Drawing illustrating traumatic aortic-right 
ventricular fistula as seen through right ventricu- 
lotomy in Case 1 . 



U.S. NAVY MEDICAL NEWS LETTER 



after being stabbed twice in the chest. Left hemo- 
thorax and pericardial tamponade were managed 
successfully by whole blood transfusion, tube thorac- 
ostomy, and pericardicentesis. While in the recovery 
room a loud, to-and-fro, continuous murmur was 
heard over the entire precordium, loudest in the 
fourth intercostal space to the right of the sternum, 
and progressive cardiac decompensation subsequently 
occurred. Right heart catheterization demonstrated 
a left-to-right shunt at the ventricular level with a 
right ventricular pressure of 26/7 mm. Hg. 

Following anatomical diagnosis right ventriculot- 
omy was performed on August 1, 1957, using total 
cardiopulmonary bypass. A 5 x 12 mm. defect was 
found in the posterior wall of the right ventricular 
outflow tract communicating with the aorta (similar 
to Fig. 4) and was repaired with interrupted figure- 
of-eight sutures. The patient's recovery was uneven- 
ful and repeat right heart catheterization demon- 
strated normal hemodynamics. He was discharged 
from the hospital on September 2, 1957, and was 
asymptomatic when last seen. 1 

Case 3: A 44-year-old man was admitted to the 
hospital on March 13, 1960, in profound shock fol- 
lowing a stab wound of the chest. Left pneumo- 
thorax and pericardial tamponade were managed 
successfully by tube thoracostomy, and pericardi- 
centesis. While in the recovery room, a loud, blow- 
ing, to 8 and-fro, continuous murmur was heard over 
the entire precordium, loudest in the third intercostal 
space to the right of the sternum. Progressive car- 
diac enlargement ensued, and right heart catheteriza- 
tion demonstrated a left-to-right shunt at the ventric- 
ular level with a right ventricular pressure of 23/3 
mm. Hg. 

Following anatomical diagnosis right ventriculot- 
omy was performed on May 10, 1960, using total 
cardiopulmonary bypass. A 5 x 10 mm. linear defect 
was found in the posterior wall of the right ventricu- 
lar outflow tract communicating with the aorta 
(similar to Fig. 4) and was repaired with inter- 
rupted figure-of-eight sutures. His course following 
operation was complicated by the onset of delirium 
tremens, from which he recovered, and he was dis- 
charged from the hospital on May 24, 1960. His 
functional cardiac status has been difficult to evalu- 
ate because of chronic alcoholism, but physical, 
roentgenographic, and electrocardiographic examina- 
tions were within normal limits when he was last 



seen. 



Case 4: A 28-year-old man was admitted to the 



hospital on June 5, 1961, in profound shock shortly 
after being stabbed twice in the left chest. Left 
pneumohemothorax and pericardial tamponade were 
managed successfully by intravenous crystalloid and 
colloid solutions, tube thoracostomy, and pericardi- 
centesis. While in the recovery room, a loud, harsh, 
blowing systolic murmur was heard along the left 
sternal border, loudest in the fourth intercostal space. 
Progressive cardiac enlargement ensued, and right 
heart catheterization demonstrated a left-to-right 
shunt at the ventricular level with a right ventricular 
pressure of 28/9 mm. Hg. 

Following anatomical diagnosis right ventriculot- 
omy was performed on June 30, 1961, using total 
cardiopulmonary bypass. A 5 x 12 mm. defect was 
found in the lower portion of the muscular inter- 
ventricular septum (similar to Fig. 6) and was 
repaired with interrupted figure-of-eight sutures. The 
patient's recovery was uneventful. He was discharged 
from the hospital on July 12, 1961, and has re- 
mained asymptomatic. 1 

Case 5: A 39-year-old woman was admitted to 
the hospital on January 14, 1961, with multiple 
lacerations and abrasions shortly after an automobile 
accident in which she had sustained a "steering wheel 
injury," followed by an episode of syncope. A loud, 
"cooing", musical diastolic murmur was heard over 
the entire precordium, loudest in the third left inter- 
costal space adjacent to the sternum with radiation 
toward the apex of the heart, and signs of aortic 
valve regurgitation developed. Right heart catheteri- 
zation revealed normal hemodynamics, and she was 
discharged on February 2, 1961, to be followed in 
the clinic. Over the ensuing months she was read- 
mitted to the hospital on several occasions because 
of shortness of breath, orthopnea, and ankle swelling. 
Right and left heart catheterizations demonstrated 
progressive cardiac decompensation, and her condi- 
tion deteriorated despite conventional cardiac medi- 
cations. 

On November 2, 1961, the aortic valve was 
exposed using total cardiopulmonary bypass. A tear 
was found in the intima of the aorta at the attach- 
ment of the commissure between the left coronary 
and the posterior noncoronary cusps of the aortic 
valve, producing regurgitation by allowing partial 
prolapse of these cusps (Fig. 5a). Repair was 
effected by placing sutures through the commissure, 
area of torn intima, and wall of the aorta, and tying 
them over baffles on the outside of the aorta (Fig. 
5b). 

The patient's initial recovery was uneventful except 



4 



U.S. NAVY MEDICAL NEWS LETTER 



for a brief episode of upper gastrointestinal tract 
hemorrhage, but the murmur subsequently recurred 
and signs of aortic valve regurgitation reappeared. 
Progressive cardiac decompensation again ensued, 
and on August 28, 1963, the aortic valve was ex- 
posed for the second time using total cardiopulmo- 
nary bypass. Recurrence of regurgitation was found 
to be due to breakage of the sutures previously used 
for repair, and at this time the leaflets themselves 
were thickened and their edges somewhat rolled. The 
major portion of the leaflets was excised and the 
aortic valve was replaced with an 11A Starr-Edwards 
ball-valve prosthesis (Fig. 5d). Her recovery was 
uneventful and she was discharged from the hos- 
pital on September 13, 1963. She has resumed 
caring for her house and her children and has 
remained asymptomatic. 3 




Fig. 5. Drawings illustrating traumatic aortic 
valve regurgitation as seen in Case 5. (a) Findings 
at first operation: aortic valve regurgitation due to 
tear in intima of aorta at attachment of commissure 
between left coronary and posterior noncoronary 
cusps allowing prolapse of cusps, (b) Technic of 
original repair passing sutures through commissure, 
area of torn intima, and wall of the aorta, tying over 
baffles on outside of aorta, (c) Findings at second 
operation: recurrence of regurgitation due to break- 
age of sutures previously used for repair. Leaflets 
thickened and edges somewhat rolled, (d) Valve 
excised and replaced with Starr-Edwards ball-valve 
prosthesis. 



Case 6: A 20-year-old man was admitted to the 
hospital on March 8, 1964, in mild shock immedi- 
ately following a stab wound of the left chest. Left 
pneumothorax and pericardial tamponade were man- 
aged successfully by tube thoracostomy and peri- 
cardicentesis. Shortly thereafter, a loud, blowing 
systolic murmur was heard along the left sternal 
border, loudest in the fourth intercostal space, and 
a gallop rhythm developed. Cardiac decompensation 
ensued but responded to digitalis therapy, and right 
heart catheterization demonstrated a left-to-right 
shunt at the ventricular level with a right ventricular 
pressure of 30/4 mm. Hg. 

Following anatomical diagnosis right ventriculot- 
omy was performed on March 19, 1964, using total 
cardiopulmonary bypass. A 15 mm. defect was 
found in the midportion of the muscular interven- 
tricular septum (Fig. 6) and was repaired with inter- 
rupted figure-of-eight sutures. The patient's recov- 
ery following operation was uneventful. He was 
discharged from the hospital on March 28, 1964, 
and has remained asymptomatic. 




Fig. 6. Drawing illustrating traumatic interven- 
tricular septal defect as seen through right ventricu- 
lotomy in Case 6. 



U.S. NAVY MEDICAL NEWS LETTER 



SUMMARY 

Experience with a large number of cardiac in- 
juries treated in the city-county charity hospitals of 
Houston and Harris County, Texas, has allowed 
development of certain principles of management. 
These include accurate evaluation, replacement of 
blood loss, and restoration of normal pulmonary 
function. Pericardial tamponade is treated prima- 
rily by pericardicentesis, reserving cardiorrhaphy for 
those patients who do not respond to pericardial 
aspiration or whose condition again deteriorates 
following pericardicentesis. 

Among these patients with cardiac injury have 
been six with hemodynamically-significant intra- 
cardiac injuries which could not have been managed 
primarily, even if immediate thoracotomy had been 
elected or necessary. Following recovery from the 



initial episode associated with wounding, an accurate 
anatomical diagnosis was made in each patient, which 
then allowed successful repair in all instances using 
total cardiopulmonary bypass. It would appear from 
this experience that recognition of such lesions now 
is of more than academic interest. 

References 

1. Beall, A. C, Jr., Morris, G. C, Jr. and Cooley, D. A. Temporary 
cardiopulmonary bypass in the management of penetrating wounds 
of the heart. Surgery, 52: 330-337, 1962. 

2. Beall, A, C, Jr., Ochsner, J. L., Morris, G. C, Jr., Cooley, 
D A. and DeBakey, M. E. Penetrating wounds of the heart. 
J. Trauma, 1:195-207, 1961. 

3. Beall, A. C, Jr. and Shirkey, A. L. Successful surgical correction 
of traumatic aortic valve regurgitation. JAMA, 187: 507-510, 1964. 

4. Beall, A. C, Jr., Shirkey, A. L. and DeBakey, M. E. Surgical 
management of cardiovascular trauma. J. Cardiov Surg. In press. 

5. Cooley, D. A,, Bealt, A. C, Jr. and Grondin, P. Open heart 
operations with disposable oxygenators, 5 per cent dextrose prime 
and normothermia. Surgery, 52: 713-719, 1962. 

6. DeBakey, M. E., Beall, A. C, Jr. and Wukasch, D. C. Recent 
developments in vascular surgery with particular reference to 
orthopaedics. Amer J Surg. In press. 

7. Parmley, L. F., Manion, W. C. and Mattingly, T. W. Non- 
penetrating traumatic injury of heart. Circulation, 18: 371-396, 
1958. 

8. Rehn, L. Ueber penetrirende Herzuden und Herznaht, Arch 
Klin Chir, 55: 315-329, 1897. 



FROM THE NOTE BOOK 



CAPTAIN A. GRAYBIEL RECEIVES AWARD 

Pensacola, Fla., May 14 — CAPT Ashton Gray- 
biel, head of the research division of the Naval 
School of Aviation Medicine here, was presented the 
CAPT Robert H. Conrad Award for scientific 
achievement here today. 

Dr, Robert W. Morse, assistant secretary of the 
Navy for research and development, presented the 
medal and citation to Dr. Graybiel during ceremonies 
dedicating the new $2.6 million school of Aviation 
Medicine. 

This was the first time this award has been given 
to a naval officer. It is presented to recognize and 
reward outstanding technical and scientific achieve- 
ment in research and development of the Department 

of the Navy. 

"The Captain Robert Dexter Conrad Award is 
the Navy's analogue to the Nobel Prize," Morse said. 
"It was established in memory and in honor of a 
scientist in uniform whose foresight and sensitivity 
helped the Navy assume a role of major national 
leadership in supporting basic research among the 
nation's universities and other research institutions," 
he said. 



The assistant Navy secretary said he was per- 
sonally delighted in the privilege of presenting the 
Conrad Award to CAPT Graybiel. 

A world renowned specialist in aeromedicine and 
related fields, Dr. Graybiel has served at the school 
here continuously for the past 23 years. He is 63 
and resides at Bayshore in Warrington, Fla. 

Secretary Morse said CAPT Graybiel's creativity 
and achievement has carried on the tradition of the 
man for whom the award is named. 

"Unlike other Navy awards," the secretary con- 
tinued, "the CAPT Conrad Award for Scientific 
Achievement is open to civilian scientists, to military 
scientists and also to scientists engaged in research 
under contract with the Navy." 

Dr. Morse noted that "this is the first time this 
award has been given to a naval officer on the basis 
of his preeminence as a research scientist." 

In lauding Dr. Graybiel's contributions to aero- 
medicine and related fields, the Navy secretary said, 
"he has been able to devote practically his full naval 
career to creative research is less known and deserves 
greater public appreciation. His career is a land- 
mark of encouragement for other naval officers whose 
creative talents in research might also be given the 



U.S. NAVY MEDICAL NEWS LETTER 



same opportunity for full expression within the naval 
environment." 

Speaking both as a scientific member of the na- 
tional community and as a spokesman for the Secre- 
tary of the Navy, Dr. Morse said he was presenting 
this award to Dr. Graybiel "as a simple token of our 
great esteem for your brilliant career as a scientist 
and naval officer." 

A native of Port Huron, Mich., CAPT Graybiel 
is a graduate of the University of Southern Cali- 
fornia and the Harvard Medical School. 

In addition to being one of the nation's top 
aviation medicine specialists, Dr. Graybiel is also 
widely known as a research physician and cardio- 
logist. 

He is married to the former Moria Berkley Martin. 
They have two children, a daughter, Ann, and a son, 
Ashton. — Public Information Office, NAS Pensa- 
cola, Fla. 



INFANT SAVED 

U. S. Naval Station, Roosevelt Roads, P. R. — 
Professional competence and quick work on the part 
of the Roosevelt Roads medical team saved the life 
of Denise Rene McMurray recently. 

Denise was born almost three months premature 
on Dec, 17, 1964 at the Station Hospital and 
weighed only 2 pounds 3 ounces. Doctors and 
nurses worked 'round the clock' to keep the infant 
alive. The child received the finest medical care 
and attention available anywhere. 

After spending three months in an incubator, 
Denise left the hospital in the arms of her parents 
Aoan and Mrs. Donald McMurray III Monday 
March 15, reportedly in fine health. 

Lieutenant Commander Robert Rack, MC pedia- 
trician, explained that Denise's development should 
be normal from now on. 




U.S. NAVAL STATION, ROOSEVELT ROADS, P. R.— Denise Rene McMurray (center), who at birth, 
Dec. 17, 1964, weighed only 2 pounds 3 ounces, received an abundance of special attention from the Roose- 
velt Roads medical team in a successful effort to save her life. Shown with Denise are her parents Aoan and 
Mrs. Donald McMurray III, and members of the medical staff: (front) Mickey Joplin, HN; the parents and 
child; and Howard Peters, HN3. (Back row) Dr. Richard Sharpe, LCDR MC; LT Joan E. Matera, NC; 
Dr. Robert Rack, LCDR MC; and LCDR Natalie T. Sampson, NC. (U.S. Navy Photo by Renaud, PH2) 



U.S. NAVY MEDICAL NEWS LETTER 



^ 



BLOOD RECRUITMENT POSTER 



HELP THE NAVY 
CARE FOR IT r 




One hundred fifty copies of the above poster are 
boosting blood recruitment at Oakland Naval Hos- 
pital's Blood Bank. 

They are on display at all naval installations in 
the San Francisco Bay Area including ships in port. 

HM3 Fred Fisher, Oak Knoll laboratory techni- 
cian-artist, created the poster on his own time after 
ENS N. M. Hirsch, MSC, medical technologist in 
charge of the hospital's blood donor center, con- 
ceived the idea for it. The finished product is a 17 x 
22-inch lithographed poster in red and black on 
white poster board. 

LT K. L. Darr, MSC, hospital contact for blood 
donors at Naval Air Station, Alameda, and HMC 
R. L, Falls, who obtains donors from U.S. Naval 
Station, Treasure Island, have found the poster an 
aid in blood recruitment. 

ACKNOWLEDGMENT 

In the U.S. Navy Medical News Letter Vol. 
45(8) :1, after "Frank C. Spencer, M.D." add "Pro- 
fessor of Surgery, University of Kentucky." 



HEROIC NAVY NURSE HAILED BY 
HOMETOWN 

Dover, N. H. — LT (jg) Ann Darby Reynolds, 
Navy Nurse, who received the Purple Heart for 
wounds suffered in the bombing of a Saigon Hotel 
while on duty with the Navy Headquarters Support 
Activities, has been given the key to the city of 
Dover, N. H., her hometown. 

Miss Reynolds also earned two letters of apprecia- 
tion while on duty in Vietnam. The first was for 
her assistance to the wounded when the USS Card 
was damaged by an explosion, and her second for 
her care to the wounded at an Army field hospital. 
—(Navy Times, 14: (29), May 5, 1965.) 

CORRESPONDENCE COURSES 

MANUAL OF THE MEDICAL DEPARTMENT 

AND 
COMBAT AND FIELD MEDICINE PRACTICE 

"The recently revised Medical Department cor- 
respondence courses "Manual of the Medical De- 
partment, Parts I, II and III" (NavPers 10708-A, 



8 



U.S. NAVY MEDICAL NEWS LETTER 



10709-A, and 10905, respectively) and "Combat 
and Field Medicine Practice" (NavPers 10706-A1) 
are now available for distribution. These courses 
are intended for both officer and enlisted personnel 
of the Armed Forces. Applications should be sub- 
mitted on NavPers Form 992 (with appropriate 
changes in the "To" line) to the Commanding Offi- 
cer, U. S. Naval Medical School, National Naval 
Medical Center, Bethesda, Maryland 20014. 

"The Manual of the Medical Department courses 
are designed to familiarize personnel of the U. S. 
Navy Medical Department with organization, admin- 
istration and management of U. S. Navy facilities 
and activities controlled by the Bureau of Medicine 
and Surgery. Completion of the fifteen (15) assign- 
ments will provide an insight into the significant 
functions of the Medical Department pertinent to the 
U. S. Navy and Marine Corps." 

"Naval Reserve retirement and/or promotion 
points will be credited for satisfactory completion 
as follows: 
Manual of the Medical Department 

Assigns. Points 
Part I (NavPers 10708-A) 4 6 

Part II (NavPers 10709-A) 5 8 

Part III (NavPers 10905) 6 9 

"It is emphasized that the course has been com- 
pletely revised. Personnel who have completed the 
previous courses (NavPers 10708-2 and 10709-2) 
will receive credit for completing the revised courses. 

"Combat and Field Medicine Practice" (NavPers 
10706-A1) is designed for the use of Medical and 
Dental personnel as a guide to help solve problems 
that could occur during all phases of amphibious 
operations, particularly those of preventive medicine, 
first aid in the field, transportation of the injured, 
surgical and medical treatment, evacuation and ad- 
ministrative procedures during combat, in all types 
of weather, climate and terrain. 

"The course consists of five (5) assignments and 
carries Naval Reserve promotion and retirement 
credit of ten (10) points. This is a minor revision 
and personnel who have completed NavPers 10706- 
A will NOT receive additional credit for completing 
this course." — Training Division, BUMED. 

PREMIERE OF BUMED FILM "NURSE CORPS, 

USN" AT AMERICAN NURSES' ASSOCIATION 

CONVENTION SAN FRANCISCO, 

CALIFORNIA 

A professional exhibit featuring the new BUMED 
color film, "Nurse Corps, USN" was displayed from 



26-30 April, 1965 at the biennial convention of the 
American Nurses' Association, San Francisco, Cali- 
fornia. 

The BUMED exhibit was highlighted by the skill- 
ful portrayal of a Navy Nurse Corps theatre featuring 
the premiere of "Nurse Corps, USN." Large groups 
of nurses and nursing students attended the premiere 
and were enthusiastic in their reception to the film. 

The 16 mm film was produced for BUMED by 
MPO studios, New York, New York. The film 
depicts a portrayal of Lieutenant (junior grade) 
June Bond's experiences during her first tour of 
duty. She recalls her activities from the time of 
her commissioning and indoctrination to her current 
assignment in an intensive care unit. Her profes- 
sional duties in nursing, administration and teaching 
as well as her social and recreational activities are 
portrayed as a "Navy way of life" and the "family 
in the Navy" of which she is a vital member. The 
film ends with a projection of the professional and 
personal opportunities that lie ahead. 

Copies of the film have been forwarded to Nurse 
Programs officers assigned to Navy Recruiting Sta- 
tions and to naval hospitals and medical activities. 
Arrangements have been made to feature the film 
on television outlets throughout the nation during 
the month of June. — Nursing Division, BUMED. 

NAVY NURSE CORPS ANNIVERSARY 
BREAKFAST 

An anniversary Navy Nurse Corps breakfast at 
the Hilton Hotel, San Francisco, on 28 May was 
attended by 125 members and former members of 
the Corps. All expressed pleasure in renewing 
friendships with retired members and meeting former 
members who had served in the Corps. Members of 
DACOWITS attending included Mrs. Lulu Hassen- 
plug, Dean, School of Nursing, University of Cali- 
fornia; Mrs, Agnes O'Brien Smith, Deputy City 
Attorney, San Francisco; and Dr. Marcia A. Dake, 
Dean, College of Nursing, University of Kentucky. 
The Consultant to the Surgeon General, Mrs. Marie 
Andrews, Associate Professor, Boston College, was 
an additional honored guest. Captain Erickson ex- 
tended greetings and congratulations to the nurses 
and spoke to them of significant milestones of the 
Nurse Corps' history. She also discussed current on- 
going projects and programs. Captain Erickson con- 
cluded her address by presenting members of the 
group who served during World War II and nurses 
who had retired. These nurses received a standing 
ovation. — Nursing Division, BUMED. 



U.S. NAVY MEDICAL NEWS LETTER 



DENTAL SECTION 



ACQUIRED DENTAL DEFECTS AND 

SALIVARY GLAND LESIONS AFTER 

IRRADIATION FOR CARCINOMA 

R. H. Frank; J, Herdley; E. Phillippe; J AD A 70(4): 
868-883, April 1965. 

A systematic study was undertaken of the dental 
defects, the saliva and the histopathologic alterations 
found in the salivary glands of patients who had been 
irradiated for cancers in the oral and pharyngeal 
regions. 

A careful examination of the oral cavity deter- 
mined each patient's dental condition and the condi- 
tion of the oral mucous membranes. It was noted 
whether the teeth were inside or out of the field of 
irradiation. Sixty-one teeth with dental defects were 
examined on decalcified and ground sections by 
routine optical microscopy and in polarized light. 
Twenty of these teeth were located inside the radi- 
ated field. Extractions were performed under local 
anesthesia with careful antibiotic medication. There 
was no development of osteoradionecrosis, confirm- 
ing the observations of Wildermuth and Cantril. 

Pooled saliva specimens were collected and a his- 
tologic study was made of salivary glands secured 
from radial neck dissections. 

The authors reported that: 

1) Diffuse superficial dental defects (carious 
lesions) developed after radiation therapy only when 
the salivary glands were in the field of radiation. 

2) When similar doses of radiation therapy were 
given directly to the jaws and teeth, but not to the 
salivary glands, such dental lesions did not develop, 
even after three years of cobalt teletherapy. 

3) The tooth surfaces involved by these dental 
defects were found to be in those areas normally 
cleansed by saliva; eg. buccal, palatal, lingual, 
smooth occlusal or incisal surfaces. The interproxi- 
mal areas and occlusal fissures were least involved. 
Histologically these defects were similar to dental 
caries. 

4) Drastic changes in the saliva were reported 
such as: 

(a) decreased volume 



(b) increased viscosity and acid pH 

(c) marked increases in organic matter. 

Therefore, the dental surfaces normally protected 
by the flow of saliva were no longer submitted to its 
protective actions. On the contrary, the tooth sur- 
faces were covered by a sticky, sloughy material 
which provided an excellent substrate for bacterial 
attack. 

The salivary alterations were felt to be related 
directly to the important pathologic changes induced 
in the salivary glands by the radiation therapy. 
These changes developed progressively for several 
months after irradiation, resulting in pronounced 
glandular atrophy. 

Regarding the relationship of oral surgery and 
exodontic procedures in irradiated mouths, the 
authors observed the following: 

1) If the salivary glands had not been irradiated 
(even though the jaws and teeth had been) dental 
defects would not develop and therefore they felt it 
unnecessary to extract healthy teeth as preventive 
measures. 

2) If the salivary glands had been irradiated, but 
the teeth and alveolar bone were outside the field of 
irradiation, dental defects did develop. However, 
since the dental and contiguous osseous areas were 
not in the field of radiation, they felt it "perfectly 
possible" to extract these teeth. In all patients who 
underwent extractions under these conditions, healing 
progressed normally, without the development of 
osteoradionecrosis or other complications. 

3) In patients whose salivary glands, teeth and 
jaws were in the field of radiation, bone vascularity 
was compromised. However, local anesthetics with- 
out vasoconstrictors and careful antibiotic coverage 
safely protected the patients from surgical compli- 
cations and the development of osteoradionecrosis. 

The authors conclude that there is more than a 
casual relationship between acquired dental defects 
after irradiation and the alterations of the salivary 
glands and the secretion of saliva. They feel a 
reappraisal of the present concepts concerning 
exodontia in patients who are to receive radiation 
therapy is indicated, and that further research is 



10 



U.S. NAVY MEDICAL NEWS LETTER 



needed to elucidate the properties of the viscid 
salivary secretions which occur as a result of gland- 
ular radiation. 

{Submitted by: Capt. S. Hoffman DC USN, U. S. 
Naval Training Center, Great Lakes, Illinois). 

Editor's Note: 

This article is of particular interest as it is closely 
related to another abstract, "Current Oral Surgical 
Opinion Concerning the Value of Pre-Irradiation 
Exodontia," published in the previous issue of the 
U. S. Navy Medical News Letter. 

Capt. Hoffman, who submitted both articles, was 
recently elevated to Fellowship in the American 
Academy of Oral Pathology. 

ULTRASONIC PROPHYLAXIS IN A NAVAL 
VESSEL 

LT S. V. Holroyd, DC USN and Capt D. L. 
Firestone, DC USN, in USS TIDEWATER (AD- 
31), have submitted a final report titled, "The Eval- 
uation of the Densply Cavitron Ultrasonic Pro- 
phylaxis Unit in a Naval Vessel," under research 
task MR 005.12-5221. In development of this 
study, BuMed approved installation of the ultrasonic 
unit in a ship subject to the following stipulations: 
"The Cavitron Dental Unit may be used aboard 
ship without special shielding, provided it is located 
in areas which are enclosed by steel bulkheads 
through which no sensitive cables (such as com- 
munications and sonar-receiving cables) pass"; and 
"The Cavitron Dental Unit must be located at least 
ten (10) feet from radio receivers and any other 
frequency sensitive lead-in cables." Having com- 
plied with these requirements, USS TIDEWATER 
experienced no problems of electronic compatibility. 

The Cavitron Unit was provided on a loan basis 
for user test, by the Densply Corporation. The Unit 
was strapped into a bulkhead-mounted angle iron 
frame, convenient to the dental operating chair. 
The manufacturer's maintenance instructions were 
followed. In approximately ten months' use, includ- 
ing a cruise from Norfolk to the Mediterranean, no 
problems, malfunctions, or disadvantages were ob- 
served. 

Three technicians, DT2, DT3, and DA, were 
trained in Cavitron prophylaxis by one week of 
instruction, followed by two weeks of closely super- 
vised clinical use. This training proved adequate. 

In 244 "light" calculus cases and 200 "moderate- 
to-heavy" calculus cases, a half-mouth cavitron and 
a half-mouth conventional prophylaxis were per- 



formed. Cavitron prophylaxis took 35% less time 
(P<.001). Conventional prophylaxis was superior 
in stain removal (P<.001); but both methods were 
satisfactory. In the "light" calculus cases, calculus 
removal was comparable for the two technics; but 
in the "moderate-heavy" calculus cases, the Cavitron 
was superior (P<.002). 

Although only slight soft tissue injuries were 
obtained with either method, the Cavitron caused 
less in "moderate-heavy" cases (P<.03). No 
difference was seen in 24-hour tooth sensitivities. 
Both patients and technicians showed a strong pref- 
erence for Cavitron prophylaxis. 

Editor's Note: The interested reader's attention 
is also called to the U. S. Navy Medical News Letter 
44(12): 12, 1964 and 45(4): 12, 1965. 

WASHINGTON'S MISSING DENTURES: 
SOLVING THE MYSTERY 

B. W. Weinberger, JADA 60(4): 542-546, April 
1960. 

The now-you-see-them, now-you-don't appearance 
of dentures supposed to have been worn by George 
Washington through the ages has generated an aura 
of mystery regarding these artifacts. The writer, 
author of the volumes, An Introduction to the His- 
tory of Dentistry in America, offers an explanation 
of why these historical displays have suddenly dis- 
appeared a number of times in the past. 

This article reveals several interesting facts about 
Washington's dentures during the last ten years of 
his life. He wore at least five different sets of 
dentures, most of which were hand carved from hip- 
popotamus ivory. Revealed too, is the myth that 
Paul Revere had constructed a wooden denture for 
the first President. 

The set of dentures presently exhibited at Mount 
Vernon are made of lead using elk's teeth. They 
weigh over two pounds and were constructed for 
the sole purpose of posing Washington for a portrait. 

TREATMENT PLANNING PRINCIPLES 
H. D. Millard, J Mich DA 46: 301-305, Nov. 1964. 

Principles of treatment planning aid in determining 
the correct choice of treatment, where a choice 
exists, and aid in the organization of a plan of treat- 
ment in a logical sequence. 

The major principles for planning treatment are: 
1. The plan must be based on accurate diag- 
nosis. 



U.S. NAVY MEDICAL NEWS LETTER 



11 



2. The patient's chief complaint must be a 
primary consideration. 

3. Past and present systemic disease must be 
considered. 

4. Influence of the personal and social history 
of the patient must be considered. 

5. The effect of past dental experiences on the 
present condition of the mouth must be evaluated. 

6. The sequence of treatment must be planned. 
A complete dental and medical history, clinical 

examination, roentgenographic survey and use of 
laboratory and other diagnostic aids are the basis 
for making a diagnosis. With a complete list of the 
oral defects which require treatment, it is possible 
to plan the various types of dental treatment in a 
logical sequence. In most instances, other than 
routine periodic visits, a chief complaint motivates 
a patient to seek dental care. The dentist should 
provide temporary or permanent relief of the chief 
complaint before proposing any extensive diagnostic 



procedures and treatment. Prompt, effective care 
of a chief complaint often builds excellent rapport 
between the dentist and his patient. 

An appreciation for the sequelae of past systemic 
disease and the implication of existing systemic 
disease is essential to correct dental treatment. 

Every dental treatment plan should include teach- 
ing the patient methods of oral hygiene which best 
meet his individual needs. The economic status of 
the patient is important in planning dental treatment, 
as is his occupation or career. 

The patient's current oral status reflects the past 
rate and progress of caries and periodontal disease. 

If each phase of treatment is rendered in proper 
sequence, optimum results will be attained. 

Errors in planning the sequence of dental treat- 
ment can be avoided if treatment is provided in the 
following order: systemic, preparatory, corrective 
and maintenance. 



PERSONNEL AND PROFESSIONAL NOTES 



Dental Office Presentations. CAPT. D. E. Cooksey, 
DC USN, Commanding Officer, U. S. Naval Dental 
Clinic, Yokosuka, Japan, presented two essays 
before the 57th Annual Meeting of the Philippine 
Dental Association 26-30 May 1965, in Quezon 
City, P. I. 

CAPT G. H. Rovelstad, DC USN, U. S. Naval 
Dental School, Bethesda; Maryland, was Moderator 
for the Scientific Section of Fluid Environment of 
the Teeth, sponsored by the Third International 
Conference on Oral Biology, before the Royal Col- 
lege of Surgeons 14-16 June 1965, in London, 
England. 

CDR. R. J. Leupold, DC USN, U. S. Naval Dental 
School, Bethesda, Maryland, presented a table clinic 
entitled "Gold Pin Inlays," before the Maryland 
State Dental Association, on 5 May 1965, in Balti- 
more, Maryland. 

CAPT. R. H. Friesz, DC USN, Executive Officer, 
U. S. Naval Dental Clinic, Brooklyn, New York, 
presented an illustrated table clinic entitled, "Mouth 
Lesions" before the 97th Annual Meeting of the 
Dental Society of the State of New York, on 5 May 
1965, in New York City. 

LCDR H. J. Keene, DC USN, U. S. Naval Train- 
ing Center, Great Lakes, Illinois, presented an essay 
entitled, "Perinatal Factors Associated with Dental 
Anomalies in Caries — Resistant Naval Recruits," 



before a Dental Anthropology class, University of 
Chicago, on 27 April 1965, in Chicago, Illinois. 

CAPT G. L. Parke, DC USN, NINTH Naval Dis- 
trict Dental Officer, and CAPT M. G. Turner, DC 
USN, Dental Officer, U. S. Naval Training Center, 
Great Lakes, Illinois, hosted eighty-two members 
and guests from the Chicago and Milwaukee Chap- 
ters of the IADR, on 22 April 1965. The guest 
speaker, Doctor R. P. Mariella, Head of the Depart- 
ment of Chemistry, Loyola University, presented a 
lecture entitled, "The Future of Science Education." 
Doctor I. L. Shklair, President of the Chicago Chap- 
ter, IADR, is Chief, Microbiologist Naval Research 
Facility, USNTC, Great Lakes, Illinois. 

CAPT R. L. Combs, Jr., DC USN, Dental Officer, 
Headquarters Support Activity, Taipei, Republic of 
China, recently announced that LT R. S. DeWaters, 
DC USNR, presented an essay entitled "Anesthetic 
Complications and Dental Office Emergencies," 
before the American Stomatological Society of 
Japan, 10-11 May 1965, at Camp Zama, Japan. 
LT J. F. Debs, DC USN, presented an essay en- 
titled, "Periodontics," before the Philippine Dental 
Association, 26-30 May 1965, in Quezon City. 

As a result of the COMNAVPHIL inspection of 
HQ Support Activity, Taipei, in November 1964, 
the Dental Department was the only department to 
receive a grade of OUTSTANDING. This is the 



12 



U.S. NAVY MEDICAL NEWS LETTER 



third year in succession that the Dental Department 
has received this grade. 

CAPT R. A. Middleton, DC USN, Chief of Dental 
Service, U. S. Naval Hospital, Oakland, California, 
presented a lecture entitled, "Inflammatory Disease 
of Salivary Glands," before members of a post- 
graduate course in Oral Surgery, at Letterman Gen- 



eral Hospital, on 9 April 1965, in San Francisco, 
California. 

Dental Service staff members and interns of U. S. 
Naval Hospital, Oakland, California, presented the 
following table clinics before the 95 th Annual Cali- 
fornia Dental Association Meeting, on 27 April 
1965, in San Francisco, California: 



CLINICIANS 

LCDR B.C. Terry, DC USN 

LCDR J. F. Hardin, DC USN 

LT. R. W. Brazil, DC USN and 
LT M, T. Jupina, DC USN 

LT J. M. Cahan, DC USN 

LT J. M. Allen, DC USN and 
LT K. G. Ponder, DC USN 

LT B. E. Sharrow, DC USN 

LT D. S. Prock', DC USN and 
LT R. L. Seberg, DC USN 



PRESENTATIONS 
"Injection Obturation In Surgical Endodontics" 
Mucogingival Surgery 
Alloy Equilibration and Finishing 

Surgical Flap Design 
Resilient Denture Bases 

Sutures and Suturing 

Combined Therapy in Treatment of Teeth 
With Furcation Involvement 



CAPT S. E. Tande, DC USN, U. S. Naval Dental 
School, Bethesda, Maryland, presented a demonstra- 
tion entitled, "Production Techniques in Pre-clinical 
Dentistry," before the 7th Annual Meeting of the 
Council on Medical Television jointly sponsored by 
the University of Michigan Medical School and Ex- 
tension Service 17-19 May 1965, in Ann Arbor, 
Michigan. CAPT Tande is Head, Audiovisual Edu- 
cation Department, U. S. Naval Dental School, 
Bethesda, Maryland. 

CAPT T. C. Pablos, DC USN, U. S. Marine Corps 
Recruit Depot, San Diego, California presented the 
following illustrated lectures: 

"Endodontic Considerations in Relation to the 
Bar Joint Fixed Partial Denture," before the San 
Diego Endodontic Seminar on 25 March 1965 and 
"The Bar Joint Fixed Partial Denture", before the 
Paul Revere Dental Study Club of San Diego on 3 
May 1965. 

Distribution of Dental Forms and Publications. The 
Dental Division has recently received an ususual 
volume of misdirected requests for various forms and 



publications. The following information should be 
brought to the attention of administrative person- 
nel: 

DENTAL ADMINISTRATION, NAVPERS 
10483 is the text for Dental Correspondence Course, 
NAVPERS 10736-B. It supersedes three publica- 
tions: DENTAL DEPARTMENT ADMINISTRA- 
TION, NAVPERS 10790A; DENTAL CLINIC 
ADMINISTRATION, NAVPERS 10789; and FIS- 
CAL AND PROPERTY MANAGEMENT IN 
DENTAL FACILITIES, NAVPERS 10840. 

One copy of DENTAL ADMINISTRATION was 

mailed to each dental activity for official use, addi- 
tional copies are NOT AVAILABLE. This would 
indicate that an accountability should be maintained 
to avoid loss of the official copy. 

BUMED NOTICE 6600 of 26 June 1964 indi- 
cated that additional copies of INDIVIDUAL 
DENTAL OFFICER— DAILY DENTAL SERV- 
ICE RECORD, NAVMED-1456 may be obtained 
by letter request addressed to BUMED Code 6113. 
Stock-piling of these forms is to be discouraged. 



U.S. NAVY MEDICAL NEWS LETTER 



13 



AVIATION MEDICINE SECTION 



PROMOTION OF FLIGHT SAFETY 
RECOGNIZED 

Norfolk — A Norfolk-based Navy captain has been 
presented the Harry G. Moseley Award by the 
Aerospace Medical Association for having made the 
"most outstanding contribution to flight safety" 
during the past year. 

CAPT Richard E. Luehrs, who heads the Aero- 
medical Department at the Naval Aviation Safety 
Center, was presented the award at the annual 
scientific meeting of the association in New York. 

More than 2,500 national and international physi- 
cians and scientists attended the four days of sci- 
entific presentations. 

The Moseley Award was established by the 
Republic Aviation Corporation in memory of Col- 
onel Moseley 's contributions to flight safety. 

Luehrs has distinguished himself in aviation safety 
throughout his entire Navy medical career. 

A graduate in medicine from the University of 
Oregon Medical School in 1946 and designated a 
naval flight surgeon in 1948 upon graduation from 
the U.S. Naval School of Aviation Medicine, he has 
served aboard 10 aircraft carriers. 

While serving as an instructor in aviation physiol- 
ogy at the school of aviation medicine, he developed 
and organized — for the first time at this school — 
courses in aviation safety, aircraft accident investi- 
gation and operational aviation medicine for student 
flight surgeons. 

He developed the first "aviation crash investiga- 
tion site" to provide practical, on-the-scene accident 
training, and also developed a portable aircraft 
accident investigation truck. 

Serving as a research assistant in the use of oxygen 
and other emergency equipment, he investigated 
electroencephalography as an objective means of dis- 
covering potential accident victims. 

Recently he has directed the medical group associ- 
ated with Army, Navy and Air Force aviation safety 
centers in establishing common definitions, termi- 
nology and coding information providing a broad 
base for information available to all three services. 



Luehrs is a diplomate in Aviation Medicine of the 
American Board of Preventive (and of the Amer- 
ican College of Preventive) Medicine, and is a 
fellow of the Aerospace Medical Association. 
— Aviation Medicine Section, BUMED. 

AVIATION MEDICAL ACCELERATION 

LABORATORY 

NAVAL AIR DEVELOPMENT CENTER 

JOHNSVILLE, PENNSYLVANIA 

It is considered that a description and accomplish- 
ment report relating to the Aviation Medical Ac- 
celeration Laboratory will be of value in establish- 
ing broad-spectrum understanding regarding the 
support to Navy operations as well as the value to 
other military departments and the National Aero- 
nautics and Space Administration. 

The Aviation Medical Acceleration Laboratory is 
situated in four buildings with a total floor space 
of 37,693 square feet. A circular building, 130 feet 
in diameter and three floors high, houses the human 
centrifuge, the animal centrifuge with an eight-foot 
arm, the research laboratory spaces, administrative 
offices, shop spaces, professional library and an 
auditorium. A wing is being added which will pro- 
vide 2,400 square feet additional floor space. The 
anticipated completion date of this wing is 23 April 
1965. 

As indicated above, a human centrifuge is housed 
in the main building. This dynamic flight simulator 
has both a closed and open loop computer capabil- 
ity. The centrifuge is driven by a 4,000 hp motor 
and consists of a 50-foot arm with a 10-foot diam- 
eter gondola capable of holding three subjects. The 
three-gimbal system of the gondola, under computer 
control, allows great versatility in the projection of 
"G" forces on the subject or equipment tested. A 
maximum of 40 "G"s, 360-degree pitch, and yaw 
and roll axes are possible. 

The Director of the Aviation Medical Accelera- 
tion Laboratory is CAPT E. M. Wurzel, MC USN 
who is assisted by 5 Navy Medical Corps and Navy 
Medical Service Corps officers and 7 enlisted men. 



14 



U.S. NAVY MEDICAL NEWS LETTER 



There are sixty -five civilians aboard, including 10 
Ph.D.'s and 7 M.D.'s. 

The Aviation Medicine Division of the Laboratory 
continues its basic functions of medical monitoring, 
collaborative support of other research divisions, 
and initiating and prosecuting its own research 
projects. Basic work on blood oxygen mechanisms 
is being conducted and reported. Other areas have 
included anti-"G" suit evaluation and medical sup- 
port of the National Aeronautics and Space Ad- 
ministration Gemini programs. 

During the past year the Physiology Division has 
developed an FM-FM biotelemetry system which 
transmits physiological data from the subject's per- 
son. In addition, this Division has been engaged in 
fundamental work involving oxygen toxicity in 
animals, as well as studying mechanisms of reaction 
of heat regulatory centers in animals. 

The Biophysics and Bioastronautics Division con- 
tinues to conduct research in acceleration protective 
devices. The efficiency of the inherently fire resist- 
ant poly amide fiber "Nomex" in fire protective gear 
was firmly established by the Thermal Branch of this 
Division. A patent has been awarded on the flame 
contact heat analyzer apparatus developed from 
this work. 

The Biochemistry Division is involved in the 
control of biological energy via neurohormonal reg- 
ulation. A free radical was found generated in both 
nerve and brain by a mechanism known to trigger 
nerve impulses in-vivo. These, together with other 
biochemical studies at the cellular level, are con- 
sidered important in that they offer some under- 
standing of the mechanisms for energy transforma- 
tions from oxygen uptake reactions in stress states. 

During the past year the Psychology Division 
prepared the written sections of the Navy-Manned 
Orbital Laboratory Documentation on human fac- 
tors, test, and evaluation of astronaut training, per- 
formance analysis, and simulation. In its Biome- 
chanics Branch, a preliminary program was com- 
pleted to determine the usefulness of powered exo- 
skeletal systems in increasing human tolerance and 
performance capabilities in high acceleration en- 
vironments. In the Human Factors Branch, data 
collection was completed upon a controlled study 
of man's ability to orient with respect to the gravita- 
tional vertical. Water immersion was utilized to 
provide equilateral support of the subject while 
positioned upon a tilt table. The second Gemini 
centrifuge simulation program has been completed. 
This program provided training for the primary and 



backup crews for Gemini GT III and GT IV. The 
efforts of the Vision Branch has been devoted to 
the problem of flashblindness from special weapons 
and related problems. A laboratory study has been 
conducted on the relation of flight adaptation and 
pupil size to recovery time from flashblindness. — 
Aviation Medicine Section, BUMED. 

AVIATORS ARE A-OK! CONFINEMENT 
STUDY A MAJOR SUCCESS 

Naval Air Engineering Center, Air Scoop 13(7):1, 
April 23, 1965. 

A substantial contribution to the manned space 
flight program was accomplished at the Naval Air 
Engineering Center Aerospace Crew Equipment 
Laboratory on Monday, April 19, when eight Navy 
and Marine Corps aviators emerged from 34 days 
of living in two sealed space chambers. 

Dirty and wearing 34-day beards, the eight came 
out of their imaginary space ships wearing full 
pressure suits. 

Since the test began on March 16 the men had 
not bathed or shaved. All they could do to keep 
clean was to wipe their faces with a damp cloth 
and brush their teeth with dry toothbrushes. 

The six who came out of the larger cylindrical 
chamber were Ltjg James B. Abbitt, USN, of Naval 
Air Station, LeMoore, California; Captain Karl A. 
Foster, USMC, of Margate City, New Jersey; Ltjg 
William R. McBride, USNR, of Chadron, Ohio; 
Ltjg Jerry W. Munger, USN, of Greendale, Wis- 
consin; Ltjg Cyrus W. Strickler, III, USN, of At- 
lanta, Georgia; and 1/Lt. Carl H. Yung, USMC, of 
Cincinnati, Ohio. 

Emerging from the "cottage", a box measuring 
12-ftxl2ftxl8-ft, were Lt Kenneth C. Juergens, 
USN, Cincinnati, Ohio; and Ltjg Richard M. Pipkin, 
USNR, of McGuire Air Force Base, New Jersey. 

The first group of six left their capsule at 7:11 
a.m. The second group came out about 7:30 a.m. 

All appeared in good health and humor, and 
joked about their "king sized five o'clock shadows". 
They had neither shaved nor bathed for 34 days. 

One of them wanted to know if it was raining 
outside and was told it was pouring. 

Lt Juergens and Lt Pipkin emerged from their 
"cottage" smiling and shaking hands with Cdr Ken- 
neth R. Coburn, MSC USN, Project Manager of 
the 34-day confinement study. 

"Feeling okay?" asked Coburn. 

"Fine," replied Juergens. 



U.S. NAVY MEDICAL NEWS LETTER 



15 



The eight men performed various tasks during 
their stay in the chambers. They were under close 
scrutiny, ate specially prepared food, listened to 
the radio, watched television — and got on each 
other's nerves. 

During 20 of the 34 days, the group of six in 
the cylindrical Bioastronautical Test Facility was 
given only pure oxygen to breathe at a pressure 
simulating conditions 27,000 feet above sea level. 

This was one of the most dangerous phases of 
the experiment because there were constant pos- 
sibilities of devastating fire. 

The project sponsored by the National Aero- 
nautics and Space Administration (NASA), was 
designed to collect and analyze a mass of data about 
the physical effects upon space crewmen of pro- 
longed stays in a low pressure but pure oxygen 
breathing atmosphere. 

The other phase was to examine the physiological 
factors of close confinement during multi-manned 
space flight missions, requiring many days of con- 
tinuous orbital or deep space flights. 

The eight were selected from a small but nation- 
wide pool of potential Navy and Marine Corps 
astronaut candidates. 

All eight passed rigid physical and psychological 
tests demanded by the project. They received inten- 
sive training at the NAEC for two weeks before they 
entered the chambers on March 16. 

For all practical purposes, the six in the steel 
chamber became an infinitely confined "space crew" 
committed to a simulated space flight mission. 

During the first seven days they lived under 
normal atmospheric conditions. They breathed an 
atmosphere containing 20 percent oxygen at a pres- 
sure of 14.7 pounds per square inch — the pressure 
at sea level. 

On the eighth day the chamber was pumped out 
to an "altitude" of 27,000 feet above sea-level and 
pure oxygen substituted for the air. At the same time, 
the total gas pressure was dropped to only five 
pounds per square inch, all of which represents the 
breathing atmosphere conditions currently accepted 
by NASA for space vehicle requirements. 

The six lived under these conditions for 20 con- 
secutive days. The chamber was restored to sea- 
level air breathing environment during the final 
seven days of the study. 

Lt Juergens and Ltjg Pipkin, lived in their capsule 
in a normal sea-level type atmosphere at all times. 



They did the same type tasks as did the group of 
six. 

They were the "control crew". Lt Juergens and 
Ltjg Pipkin were the test subjects upon whom the 
greatest emotional stress was placed. 

The entire experiment depended on a compari- 
son of the behavioral patterns between the two 
groups. 

Their experience may provide badly wanted an- 
swers to the critical question of whether or not only 
two crewmen can live harmoniously together under 
prolonged space mission confinement conditions. 

There is no detectible difference between air at 
sea level or pure oxygen at 27,000 feet as far as 
the subject is concerned, but there is considerable 
difference between living conditions among six con- 
fined crewmen as compared to only two with re- 
spect to monotony and emotional stability required 
to survive it. 

A formidable mass of experimental tests and ob- 
servations were made on all eight subjects. An 
organized team of more than 50 specialists, includ- 
ing physiologists, flight surgeons, psychologists, bac- 
teriologists, engineers and skilled technicians, both 
Navy and civilian, gathered mounds of data and 
managed the complex operation according to a 
typical Navy task force approach. 

These efforts were carried out on a round-the- 
clock basis. All volunteers were kept under con- 
tinuous surveillance via closed circuit television, as 
well as by direct vision if required for their safety. 
In fact, they were kept under close scrutiny at all 
times. 

An important aim was to determine the ability 
of a space crew to live continually in an at least 
partially donned space suit for many days. 

Sudden failure of the normal protection in a 
space ship would require an astronaut to seal him- 
self in a space suit if he was to survive. 

All eight men wore full pressure suits for three 
weeks, and parts of suits during the rest of the time. 

Each subject had a busy but closely regulated 
schedule of activities to follow daily. Meals were 
taken four times daily from compact NASA-pro- 
vided space rations which were specially prepared 
by the men themselves. 

Calories (2500 daily) were precisely counted. 
Personal hygiene practices were strictly tailored to 
space mission requirements. 

Intensive work schedules were followed. Leisure 



16 



U.S. NAVY MEDICAL NEWS LETTER 



time was provided but strictly rationed and a space 
crew duty shift-system was followed. 

These men were subjected to a rough ordeal (but 
each was chosen for his ability to succeed). 

Periodic measurements were made to determine 



whether or not changes had occurred in the blood 
of the men, whether there were changes in pul- 
monary functions, energy and nutritional balance, 
water balance and psychological stability. — Aviation 
Medicine Section, BUMED. 




Press Conference in session. Left to rishi: Ltjn Jerry W. Miineer. Lijr. Cyrus \\. Striekler, Ill l/l.i. Carl 
H. Yiuik, D8KC; IX Kenneth C, Juergens, URN; C4r. Kenneth R. Cobarti. Project Manager; Captain II. G. 
Wagner, Director, ACKL; Captain S. B. Onrs, CaadBnQ (Klicrr. :v\tA': BE Roger Ireland. Deputy Director. 
ACKL: Captain Karl A.. Foster, USMC; Ltjg James U Abbitt. CSV; Uiz. Richard St Pipkin. CSXR: and Ltjs. 
William B. M. Iltide. USNK. 

EJECTION VERTEBRAL INJURIES 



For those who have studied ejection statistics, it 
becomes readily apparent that there is more than 
one factor which comes into play when ejection 
vertebral injuries are analyzed. In fact, there may 
be no listing that can be made of factors in order 
of their cause due to the variance of factors in 
ejections and their interplay roles. However, some 
statistical trends may be shown to occur. These 
trends can be used in human factors engineering 
in design guidelines for ejection systems. Further- 
more, some trends may show areas in which train- 
ing emphasis may provide a valuable supplement 
in reducing vertebral injury incidents in some opera- 
tional ejection seat systems. 

Some major factors involved in ejection seat 
vertebral injuries include the following: 

1. Thrust characteristics of the ejection seat 
propulsion system. 

2. Pre-ejection body position of the ejectee. 

3. Shape, retention, rigidity, and resonance char- 
acteristics of the survival pack and seat cushion 
assembly in the seat pan. 

4. Harness restraint systems and the related 
user's wear-condition. 

5. Presence of negative "G" at the time of ejec- 
tion. 

6. Dynamic response of the human body to a 
given input thrust. 

Propulsion System Type: 
Multi-Charge Catapult System: 
Rocket-Catapult System: 



LT W. L. Smith, MSC, USNR 

1. "Through-the-Canopy" ejections. 

It is the purpose of this paper to demonstrate 
how some of these factors may be causative agents 
in ejection vertebral injury. 



Propulsion Systems 

All things being equal, it is a logical assumption 
that the "softer" the "G" onset and duration of ap- 
plication, the lower will be the vertebral injury in- 
cidence. This particular thesis can be proven by 
looking at the U.S. Navy CY 1964 ejection data 
where the incidence of vertebral injury in multi- 
charge catapult systems is consistently higher than 
for the catapult-rocket systems. For the multi- 
charge catapult system, there were 79 known ejec- 
tions with 1 1 of these having vertebral injury for a 
total of 14 percent versus the catapult-rocket propul- 
sion system in which there were 56 known ejections 
with 2 cases of vertebral injury for a total of 3.6 
percent. In this paper "known" applies to ejections 
for which airspeed and/or altitude were known and 
where the vertebral injury was due to ejection forces. 

To provide a fair evaluation of any ejection sys- 
tem, it must be remembered that a measure of its 
success is its recovery of aircrew personnel. In this 
context, the same data provides the following: 

Percent-Successful Aircrew Recovery 
approx. 90% 
approx. 80% 



U.S. NAVY MEDICAL NEWS LETTER 



17 



Even these data must be taken with caution due to 
the fact that the statistical sample is small and can 
be only said to be true for CY 1964. Some of the 
fatalities represent ejections out of the design enve- 
lope of the ejection seat. 

Pre-Ejection Position 

Pre-ejection position can be a critical factor in 
prevention of vertebral injuries, but as to what 
degree is still hard to ascertain. There have been 
isolated incidents where the ejectee has been in the 
worst possible pre-ejection position with no vertebral 
injury occurrence. With reference to the CY 1964 
data, only one vertebral injury case can be attributed 
to mal-positioning. This fact is a credit to the Navy 
training program conducted at the Aviation Physiol- 
ogy Training Units throughout the fleet. Emphasis 
on "dry" runs at the squadron level in unarmed 
seats is also extremely important. The combination 
of these training programs is essential to point up 
errors in pre-ejection positioning and ejection initiat- 
ing techniques. 

Survival Packs and Seat Cushions 

In the current fleet configurations of this equip- 
ment, there is a great deal of variation. Some seat 
configurations have packs which are separate from 
the seat cushion, while the cushion itself is located 
on brackets on the seat pan. Another configuration 
has the pack which fits the seat pan with shaped 
cushion tops. The former configuration is found in 
a multi-charge catapult system in which vertebral 
injury incident is high; i.e., the TF9J series. For CY 
1964 the TF9J had a total of 5 known ejections 
with 4 vertebral injury cases to provide an 80% 
incidence of vertebral injury. A more representative 
figure can be found in a recent study covering four 
years of ejections in the TF9J. This study indicated 
a 46% vertebral injury incidence represented by 47 
vertebral injury cases of 103 ejection events. The 
percentage for this particular seat and seat pan/ 
cushion configuration has been consistently high, as 
much as four times greater incidence, when com- 
pared to other multi-charge catapult systems. 

Here it is important to point out the very crucial 
nature of a good one-to-one ratio, man-seat coupling 
system so that such things as overpeaking of man's 
output "G" does not exceed the propulsion's input 
"G". If a "soft" seat cushion is employed for com- 
fort considerations, it is not difficult to obtain as 
much as a 50% increase in peak "G" force for the 
man. 



Harness Restraint Systems and 
User Adjust-Condition 

The development of harness restraint systems for 
Navy ejection seats has been directed towards an 
integrated torso harness concept to provide the best 
man-seat coupling system available. If the user's 
adjust-condition with this system is a loose fit, he 
will find himself in high probability of back injury 
if he must eject. 

A recent study of the Royal Navy versus the 
Royal Air Force vertebral injury for a specific multi- 
charge catapult gun system showed that the Royal 
Navy spinal injury rate is only half that of the Royal 
Air Force. It was suggested by the author that this 
difference was due to the way in which the Royal 
Navy aircrew personnel strap themselves into their 
seats. Naval aviation personnel are subjected to 
catapult/ arrest "G" forces; therefore, they have the 
tendency to wear their harness restraint systems in a 
tight fit condition. A similar conclusion was drawn 
in the paper "RCAF EJECTION EXPERIENCE 
1952-1961" by S/L JR Smiley, C. D., RCAF Insti- 
tute of Aviation Medicine, which compared similar 
catapult systems and showed a 17% difference in 
vertebral injuries for the U.S. Navy versus the 
RCAF. The 17% higher incidence in fractured 
vertebrae for the RCAF was attributed to loose-fit 
condition of their harness restraint systems. 

Negative "G" 

The presence of negative "G" compounds the 
problems of trying to provide an adequate man-seat 
close couple system. In CY 1964 three (3) ejection 
vertebral injury cases were attributed to negative 
"G" forces present at the time of ejection. Improved 
restraint systems may even reduce ejection vertebral 
injury under negative "G" conditions. If not worn 
properly, no harness restraint system will provide 
proper protection at ejection under negative "G" 
conditions. 

Dynamic Response of the 
Human Body 

Simulation programs designed to mimic the human 
body response to input accelerative forces and 
resultant functional changes in these forces which 
occur with seat configuration changes would be of 
great importance to escape systems designer engi- 
neers. 

Basic biomedical data is still being collected. 
Human tolerance curves are subsequently being 
redefined. With accrual of the above mentioned 



18 



U.S. NAVY MEDICAL NEWS LETTER 



data, it is hoped that better understanding of man's 
tolerance to accelerative force will lead to reduced 
injury. 

"Through-the-Canopy" Ejections 

Another contributing factor in ejection vertebral 
injuries is through the canopy ejections. There is a 
high coincidence of vertebral injuries with this mode 
of ejection. A case in point is found in the CY 1964 
for the TF9J ejections. Three out of four vertebral 
injury cases occurred with "through-the-canopy" 
ejections. Again this sample is small in number but 
a relationship does seem to exist in the overview of 
ejection data. 

Other Factors 

There are many factors which have been men- 
tioned by other authors that have not been presented 
in this paper. Some of those factors are more diffi- 
cult to substantiate in the opinion of this author, 
and therefore have not been mentioned. 

Conclusion 

There is no common denominator, the removal of 
which will delete spinal injuries from ejections. 
Spinal injuries are caused by many factors in which 
there is interplay of varying degrees. The statistical 
numbers are not adequate to provide data in which 
a degree of significance can be placed. The large 
variety of ejection seat configuration and engineering 
changes further complicates the job of analysis. 

In general, the most important area of considera- 
tion for ejection vertebral injuries reduction is in the 
area of the man-seat coupling system. This means an 



adequate harness/restraint system adjusted properly, 
a shaped seat cushion with a hard seat pack with 
restricted "bottoming", and good pre-ejection posi- 
tioning of the ejectee. — Aviation Medicine Equip- 
ment and Requirement Section, BUMED. 

BUMED INSTRUCTION 6110.8 

This BUMED Instruction set forth the required 
anthropometric measurements on aviation physical 
examinations and revised the height standards appli- 
cable to candidates for flight training. The Instruc- 
tion directed aviation activities conducting aviation 
physicals to construct the anthropometer utilizing 
local funds and a set of drawings obtained from 
the Naval Air Technical Services, Philadelphia, 
Pennsylvania. 

Subsequent to the distribution of BUMED Instruc- 
tion 6110.8, inputs to BUMED and BUWEPS from 
a large segment of aviation activities and ships indi- 
cated difficulty in funding and fabrication of the 
anthropometer. Included were a large number of 
suggestions aimed toward the alleviation of the prob- 
lem. 

Recently the BUMED, BUWEPS liaison officer 
completed arrangements for centralized funding and 
procurement of a sufficient quantity of the anthro- 
pometers to meet naval aviation requirements. A 
contract is in the process of establishment whereby 
the Aerospace Crew Equipment Laboratory, NAEC, 
Philadelphia, Pennsylvania, 19112, will monitor and 
distribute complete anthropometers to each user 
activity upon request. It is anticipated that delivery 
to ACEL will get under way during October or 
November 1965. — Aviation Medicine Section, BU 
MED. 



RESERVE SECTION 



To: Lieutenant Commander Norman L. Mauroner, 
MC 474310/2105 USNR-R 

Subj: APPRECIATION FOR MEDICAL 
SERVICES RENDERED 

In view of your outstanding devotion to duty and 
high regard for the physical and mental health of 
each Marine of Company L, Third Battalion, 24th 
Marines, 4th Marine Division, FMF, USMCR, 
Shreveport, Louisiana as the unit Medical Officer, I 
would like to take this opportunity to express my 



sincere appreciation for all medical services you 
have rendered our Marines in that unit. 

You have on many occasions devoted long hours, 
not required of you in your capacity as a Reserve 
Medical Officer, to the health and welfare of both 
the Reservists and Regulars within the organization. 
In addition to your military functions as Unit Med- 
ical Officer, you have given up many hours of your 
private practice in the care of the dependents of the 
Inspector-Instructor Staff thus eliminating many 
medical problems for Marine Corps Families in the 
area. 



U.S. NAVY MEDICAL NEWS LETTER 



19 



Your initiative, hard work and devotion to duty 
have not gone unnoticed. By working your sched- 
ule around those of our reservists and regulars 
coupled with a "Can Do" attitude, you have con- 
tributed materially to the overall morale and effi- 
ciency of the Shreveport Unit. 

Your attention to duty and keen interest in the 
Marine Corps Reserve Program is in keeping with 
the highest traditions of the Naval Service and I 
take pleasure at this time in commending you for 
your faithful, timely and effective attention to duty 
as Medical Officer of the Shreveport Marine Corps 
Reserve Unit. 

S/R. L. STALLINGS 

LETTERS OF COMMENDATION 

To: Commanding Officer, Naval Reserve Surface 
Division 5—43 (S), Adelphi, Maryland, Active 
Duty for Training 

1. During the period 19 — 29 April, 1965, the group 
of four officers and twelve hospital corps personnel 
of your division have been deployed in an active 
duty for training status to this command. 

2. Your duties in this command have been per- 
formed in an outstanding manner both as individuals 
and as members of our hospital staff. The entire unit 
displayed a refreshing eagerness to learn and an 
alert responsiveness to help in all situations when 
needed. 

3 . The members of this unit of the Reserve Surface 
Division 5-43 (S) are commended for their interest 
and participation in -the prescribed training offered. 
This well trained unit is a credit to the entire Re- 
serve Division and the Naval Reserve. It is through 
organized efforts such as yours that the spirit of con- 
tributing to the strength of our Navy and the nation 
is exemplified most clearly. 

4. I extend to you and the members of the Reserve 
Surface Division 5-43 (S) a hearty "Well Done". 
My congratulations and best wishes are offered for 
continued success in your future endeavors. 

5. A copy of this letter will be made a perma- 
nent part of the official service records of your unit's 

personnel. 

S/H, A. MARKOWITZ 

To: Commander Max C. McCowen, MSC, USNR 
1. The Commandant takes pleasure in awarding 
this letter of commendation to you as Commanding 
Officer of Naval Reserve Medical Company 9-3. 
Naval Reserve Medical Company 9-3 attained first 
place in competition with eleven other medical com- 



panies participating in the Ninth Naval District 
Program. 

2. This creditable performance of Naval Reserve 
Medical Company 9-3, is the result of the high de- 
gree of leadership exercised by you as Commanding 
Officer and the outstanding cooperation and per- 
formance of duty by the officers under your com- 
mand. I commend you, and the officers of your 
Company, for excelling other Medical Companies 
in the Ninth Naval District. 

3. The Ninth Naval District "First Place Plaque" 
awarded annually for permanent retention is hereby 
presented to Medical Company 9-3 in recognition of 
this achievement. 

4. The Commanding Officer is authorized and di- 
rected to reference this letter and append a copy 
thereto on the fitness reports of officers under his 
command when next submitted. In those cases when 
fitness reports will not be submitted, a copy of this 
letter shall be forwarded separately to the Chief of 
Naval Personnel (Pers E-221) for inclusion in the 
officers' records. 

S/ HA. YEAGER 

MEDICAL AND DENTAL STUDENTS 
ABOARD USS HUSE 

Eighty-five medical and dental students and their 
dates clambered aboard the New Orleans-based 
destroyer escort USS Huse, March 7, for a day-long 
cruise on the Mississippi River. 

The students, 60 medical students from Tulane 
University Medical School and 25 dental students 
from Loyola University Dental School, were encour- 
aged to bring their wives or sweethearts on the cruise 
so that not only they, but the ladies as well, would 
gain an insight into Navy life. 

During the cruise the guests observed points of 
interest along the banks of the Mississippi, watched 
typical at-sea evolutions, and were treated to a 
Navy-style buffet lunch on the ship's fantail. CAPT 
R. K. Brooks, MC, USN, Eighth Naval District 
Medical Officer, was on hand to answer questions 
about Navy medicine. 

The cruise was the second of its kind originated 
by Dr. Brooks, who fostered a similar cruise with 
Louisiana State University Medical students in 
November 1964. The March 7 cruise was made 
under the auspices of RADM Charles H. Lyman, 
USN, Commandant of the Eighth Naval District, and 
LCDR F. F. Ames, USNR, commanding officer of 
the USS Huse. — Navy News Release, March 11, 
1965. 



20 



U.S. NAVY MEDICAL NEWS LETTER 



EDITORIAL DESK 



CAPT. VORIS RECEIVES INTERNATIONAL 

ACADEMY MEMBERSHIP CERTIFICATE 

FROM ADMIRAL GALANTIN 

CAPT Frank B. Voris, MC USN, received the 
certificate and medallion certifying his membership 
in the International Academy of Aviation Medicine 
in ceremonies held in Washington D. C, on March 
25, 1965. The presentation was made by Vice Ad- 
miral I. J. Galantin, Chief of Naval Material. Cap- 
tain Voris is Assistant for Medical and Allied 
Sciences in the Exploratory Development Division 
of Admiral Galantin's office. Captain Voris — 
President-Elect of the Aerospace Medical Associa- 
tion, is one of only seven Navy captains who are 
both medical officers and naval aviators. He has 
more than 2,600 flying hours as a pilot. Captain 
Voris, who began his Naval career in 1941, has had 
varied assignments. After attending the Navy 
School of Aviation Medicine, he took part in the 
North African campaign as flight surgeon aboard 
the escort carrier Sangamon. In 1943, he transferred 
to Carrier Air Group 3, embarked in the carrier 
Yorktown (World War II's famed "Fighting Lady"), 
and participated in seven major engagements and 
campaigns in the South and Western Pacific. He 
won the wings of a naval aviator in 1948. Since 
then, his service has included tours of duty in 
Hawaii, in the Navy's Bureau of Medicine and 
Surgery in Washington, D. C, and as senior medical 



officer aboard the carrier Forrestal. His last prior 
assignment was as Chief of the Human Research 
Branch, NASA. Full membership in the Interna- 
tional Academy of Aviation Medicine is limited to 
200, although current membership is under 100. To 
be eligible for membership, a candidate must be a 
doctor of medicine, over 40 years of age, and have 
more than 10 years' specialization in Aviation 
Medicine. 

— Aerospace Medicine 36(5) :494, May 1965. 

SECRETARY OF THE NAVY COMMENDS 
NAVY MEDICAL DEPARTMENT 

I should like to acknowledge the outstanding work 
being done in Southeast Asia by Navy medical per- 
sonnel. Navy medical officers and enlisted men 
assigned to the Republic of Vietnam are engaged 
not only in medical support of our own and South 
Vietnamese forces there, but in various civic action 
programs for the benefit of the civilian population. 
Specialists in surgery, anesthesiology and orthopedics 
are in particularly heavy demand in Vietnam, and this 
has increased the already heavy workload for those 
remaining in this country. Our medical personnel 
in Southeast Asia are working long hours under 
arduous conditions. We have asked, and they are 
giving, the exemplary service which we have come 
to expect from that skilled and dedicated corps of 
men and women. — SECNAV Address 7 June 1965. 



POSTGRADUATE SHORT COURSES FOR MEDICAL DEPARTMENT OFFICERS 
SPONSORED BY THE DEPARTMENT OF THE ARMY DURING FISCAL 

YEAR 1966 



The following postgraduate professional short 
courses will be conducted by the Army Medical 
Service during Fiscal Year 1966. Officers desiring 
to attend should submit their requests in ample time 
to reach the Bureau at least 8 weeks prior to the 



convening date of the course desired. This lead time 
is necessary in order to comply with the Army's 
request to return unused quotas 6 weeks in advance 
of the convening dates of the courses listed. 



Courses 

Armed Forces Examining 

Station Examiners 



Ophthalmic Pathology 
Orthopaedic Pathology 



Installation 
Medical Field Service 
School, Brooke Army 
Medical Center 



Armed Forces Institute 
of Pathology 
Armed Forces Institute 
of Pathology 



Date 

12-19 Aug 1965 
20-24 Sep 1965 
1-5 Nov. 1965 
7-11 Feb 1966 

MC 
13-17 Sep 1965 

MC 
27 Sep— 5 Nov 1965 

MC 



U.S. NAVY MEDICAL NEWS LETTER 



21 



Courses 

Trends in Dental Laboratory 
Activities 

Eighteenth Annual Symposium 
on Pulmonary Disease 
Medical Management of Mass 
Casualties 

Post Graduate Course in 

Prosthodontics 

Kimbrough Urological Seminar 

Preventive Dentistry 



Current Concepts of Medical 
Support in Future Warfare 
Introduction to Research Methods 

Advanced Course in Aerospace 

Pathology 

Introduction to Electron Microscopy 

Present Concepts in Internal 

Medicine 

Fundamentals of Medical Support 

in Modern Warfare 

Post Graduate Course in 
Restorative Dentistry 
Prosthodontics 



Nursing Practice in the Military 

Application of Histochemistry to 

Pathology 

Neuropathology 

Oral Surgery 



Advanced Medical Operations 
in Modern Warfare 

Surgical & Orthopedic Aspects 

of Trauma 

Advances in Instrument Analysis 

Ophthalmic Pathology 



Installation 

Army Institute of Dental 

Research, Walter Reed 

Army Medical Center 

Fitzsimons General 

Hospital 

Medical Field Service 

School, Brooke Army 

Medical Center 

Letterman General 

Hospital 

Letterman General 

Hospital 

Army Institute of Dental 

Research, Walter Reed 

Army Medical Center 

Walter Reed Army 

Institute of Research 

Armed Forces Institute 

of Pathology 

Armed Forces Institute 

of Pathology 

Armed Forces Institute 

of Pathology 

Letterman General 

Hospital 

Medical Field Service 

School, Brooke Army 

Medical Center 

Letterman General 

Hospital 

Army Institute of Dental 

Research, Walter Reed 

Army Medical Center 

Walter Reed Army Institute 

of Research 

Armed Forces Institute 

of Pathology 

Armed Forces Institute 

of Pathology 

Army Institute of Dental 

Research, Walter Reed 

Army Medical Center 

Medical Field Service 

School, Brooke Army 

Medical Center 

Brooke General Hospital 

Walter Reed Army Institute 
of Research 
Armed Forces Institute 
of Pathology 



Date 

27 Sep— 1 Oct 1965 
DC 

20-24 Sep 1965 

MC 
25-29 Oct 1965 

MC 

11-15 Oct 1965 

DC 
25-28 Oct 1965 

MC 
25-29 Oct 1965 

DC 

15-19 Nov 1965 

MC, NC 
1-5 Nov 1965 

MC 
16-18 Nov 1965 

MC 
29 Nov— 3 Dec 1965 

MC 
2-5 Nov 1965 

MC 
29 Nov— 10 Dec 1965 

MC, NC 

6-10 Dec 1965 

DC 
6-10 Dec 1965 

DC 

24 Jan— 4 Feb 1966 

NC 
17-21 Jan 1966 

MC 
31 Jan-^1 Feb 1966 

MC 
10-14 Jan 1966 

DC 

14 Feb— 18 Mar 1966 
MC 

7-11 Feb 1966 

MC 
21 Mar— 29 Apr 1966 

MSC 
7-11 Mar 1966 

MC 






22 



U.S. NAVY MEDICAL NEWS LETTER 



Courses 


Installation 


Date 


Pathology of the Oral Regions 


Armed Forces Institute 


14-18 Mar 1966 




of Pathology 


MC 


Annual Armed Forces Institute 


Armed Forces Institute 


28 Mar— 1 Apr 1966 


of Pathology Lectures 


of Pathology 


MC 


Advanced Military Nursing 


Medical Field Service 


7-18 Mar 1966 




School, Brooke Army 


NC 




Medical Center 




Advanced Pathology of the Oral 


Army Institute of Dental 


7-11 Mar 1966 


Regions 


Research, Walter Reed 
Army Medical Center 


DC 


Pediatric Tri-Service Seminar 


Walter Reed General 


2-4 Mar 1966 




Hospital 


MC 


Geographic Pathology of Infectious 


Armed Forces Institute 


4-8 Apr 1966 


Diseases 


of Pathology 


MC 


Otolaryngology Basic Science 


Armed Forces Institute 


4 Apr— 27 May 196( 




of Pathology 


MC 


Forensic Pathology 


Armed Forces Institute 


18-22 Apr 1966 




of Pathology 


MC 


Oral Surgery 


Letterman General 


4-8 Apr 1966 




Hospital 


DC 


Symposium on Current Surgical 


Walter Reed General 


4-6 Apr 1966 


Practices 


Hospital 


MC 


Oral Diagnosis and Therapeutics 


Army Institute of Dental 


2-6 May 1966 




Research, Walter Reed 


DC 




Army Medical Center 




Principles of Military Dental 


Army Institute of Dental 


16-20 May 1966 


Research 


Research, Walter Reed 
Army Medical Center 


DC 



— Professional Division, BUMED. 



AMERICAN BOARD CERTIFICATIONS 



American Board of Obstetrics and Gynecology 
LCDR Warren J. Jones, Jr., MC USN 
LCDR Richard T. Upton, MC USN 

American Board of Orthopedic Surgery 
LCDR Robert C. Colgrove, MC USN 
LCDR Robert I. Sorenson, MC USN 

American Board of Otolaryngology 
LCDR James P. King, Jr., MC USNR 



American Board of Pathology 

CAPT Elgin C. Cowart, Jr., MC USN 

American Board of Preventive Medicine 
CDR Charles H. Miller, MC USN 

American Board of Radiology, including Nuclear 
Medicine 

LCDR Francis L. Maher, MC USN 
LCDR Richard B. Simpson, MC USN 



3n jllemortam 



RADM Charles "S" Stephenson MC USN (Ret) 
CAPT Malcolm W. Arnold MC USN (Ret) 
CAPT Leon D. Carson MC USN (Ret) 
CAPT Bruce H. McKinney DC USN (Ret) 
CAPT Henry A. Monat MC USNR (Ret) 
CAPT Clarence C. Myers MC USN (Ret) 
LT Howard E. Berry MC USNR 
LT William T. McAlpin MSC USN (Ret) 
LT Edwin Stuart Warrell MSC USN (Ret) 
Chief Nurse Florence M. Vevia USN (Ret) 



9 February 


1965 


6 May 


1965 


9 January 


1965 


22 January 


1965 


25 January 


1965 


21 May 


1965 


9 May 


1965 


6 February 


1965 


3 February 


1965 


5 February 


1965 



U.S. NAVY MEDICAL NEWS LETTER 



23 



DEPARTMENT OF THE NAVY 

U. S. NAVAL MEDICAL SCHOOL 

NATIONAL NAVAL MEDICAL CENTER 

BETHESDA. MARYLAND 20014 



POSTAGE AND FEES PAFD 
NAVV DEPARTMENT 



OFFICIAL BUSINESS 



PERMIT NO. !04S 



U.S. NAVY MEDICAL NEWS LETTER